Saturday, March 30, 2013

A Reuters news article that was written by Anthony Boadle and published on March 28 has reported that Dr. Virginia Soares de Souza has been charged with 7 counts of murder and may have killed 300 patients in order to, reportedly, "free-up" beds. (Doesn't that sound familier) It has been suggested that de Souza could be one of the world's worst serial killers.

Several years ago I heard a talk by a Dutch physician who did euthanasia. He referred to the patients who were nearing death, but not dying quickly, as "bed blockers." I was shocked that he suggested, so plainly, how euthanasia was solving the problem of the "bed blocker".

In case you think that Dr. de Souza is unique, you may remember Dr. Harold Shipman who may have killed around 250 patients in England and was convicted of 15 murders. Then there was Dr. Michael Swango, the American doctor who may have killed 60 patients and more recently there was the Finnish nurse Aino Nykopp-Koski who was convicted of killing 5 patients. Link to an article.

If we examine three recent studies from theFlandersregion ofBelgium we find that:

The study concerning the role of nurses found that 14 nurses admitted to euthanizing their patient and 2 stated that it was done without the permission of the doctor. It is important to note that the Belgian euthanasia law does not permit nurses to euthanize their patients.

Considering the fact that only a few doctors do most of the euthanasia deaths, it is likely that the reason the abuse of euthanasia exists in Belgium and the Netherlands is because doctors are actually masking their euthanasia practise under the guise of compassion, where in reality it is a cover for their enjoyment of the power that euthanasia gives them over life.

Once euthanasia becomes legal, then the only difference between an act of killing a patient and an act of murder is whether or not the patient consented. As you notice from the Belgian stats, euthanasia without explicit consent is common. The fact is that the euthanasia law acts as a cover for doctors who take the law in their own hands. Euthanasia acts as a cover for a serial killer because their act goes from reprehensible to respectable.

BRASILIA - A Brazilian doctor who was charged with killing seven patients to free up beds at a hospital intensive care unit may have been responsible for as many as 300 deaths, according to a Health Ministry investigator.

Prosecutors said Dr. Virginia Soares de Souza and her medical team administered muscle relaxing drugs to patients, then reduced their oxygen supply, causing them to die of asphyxia at the Evangelical Hospital in the southern city of Curitiba.

De Souza, a 56-year-old widow, was arrested last month and charged with seven counts of aggravated first degree murder. Three other doctors, three nurses and a physiotherapist who worked under De Souza have also been charged with murder.

Prosecutors for the state of Parana said wiretaps of De Souza’s phone conversations revealed that her motive was to free up hospital beds for other patients.

“I want to clear the intensive care unit. It’s making me itch,” she said in one recording released to Brazilian media. “Unfortunately, our mission is to be go-betweens on the springboard to the next life,” she added in the same phone call.

De Souza’s lawyer, Elias Mattar Assad, said investigators had misunderstood how an intensive care unit works and she would prove her innocence.

More cases are expected to emerge as investigators comb through 1,700 medical records of patients who died in the last seven years at the hospital, where De Souza headed the intensive care unit.

“We already have more than 20 cases established, and there are nearly 300 more that we are looking into,” the chief investigator assigned by Brazil’s Health Ministry, Dr. Mario Lobato, said on Globo TV’s Fantastico program on Sunday.

If prosecutors prove that De Souza killed 300 patients, this could be one of the world’s worst serial killings, rivaling the notorious case of Harold Shipman, the English doctor who was found to have killed at least 215 patients.

Lobato said the deaths he reviewed occurred under similar circumstances: a muscle relaxant such as Pancuronium (trademark Pavulon) was administered, increasing the patients’ dependence on artificial respiration; then the oxygen supply was reduced, causing death by asphyxia.

Some of the patients were conscious moments before they died, he said.

Prosecutors said De Souza felt “all powerful” running the intensive care unit homicide, to the point where she “had the power to decree the moment when a victim would die.”

In some cases, De Souza was absent from the hospital and gave instructions to end the life of a patient by telephone to members of her medical team, according to documents detailing the charges.

Last week, a Curitiba judge ordered the release of De Souza and her medical team. Prosecutors sought on Monday to have her returned to custody because she was the leader of the team and witnesses had reported being intimidated.

Parana state prosecutors asked police on Wednesday to investigate whether more hospital employees, including former managers, were involved in the case.

President Dilma Rousseff’s government will announce steps on Thursday to reorganize the hospital, a spokesman for the Health Ministry said.

It’s been awhile since we’ve written about the Final Exit Network (FEN), but there are new developments in the criminal case against members of the group. You can read earlier posts on the case in Minnesota here, here, here and here.

A Minnesota judge has ruled that part of the state’s law against assisted suicide is unconstitutional, in a ruling that could bolster right-to-die advocates’ efforts to overturn it.

Judge Karen Asphaug made the decision in striking charges on March 22 against Thomas Goodwin, the former head of the Final Exit Network, a right-to-die group that has been accused of illegally assisting in the death of a 57-year-old woman suffering from chronic pain.

It’s a felony in Minnesota to intentionally “assist, advise or encourage” suicide. Asphaug ruled that “advising” infringed on Goodwin’s right to free speech, since there was no evidence to directly implicate him in the woman’s death, and was therefore unconstitutional. The judge also struck down an assisted suicide charge and a charge for interfering with a death scene against one member, Roberta Massey.

There are still serious charges against the two remaining defendants:

The Final Exit Network and the two remaining defendants still face serious charges:

Lawrence Egbert, 84, who worked as Final Exit Network’s medical director, reviewed applications from people wishing to end their lives. Prosecutors say Egbert flew to Minnesota the day Dunn died. Egbert has been charged with two felony counts of assisting in a suicide, and two misdemeanors counts of interfering with a death scene.

Roberta Massey, 66, was a case coordinator, prosecutors say, and had contact with Dunn on the phone. One count of assisting with a suicide and another of interfering with a death scene was dropped against her last week, but she still faces one felony count of aiding others to assist in a suicide.

A third defendant in the case, Jerry Dincin, faced the same charges as Egbert. Today, the network announced that he had died of cancer, at age 82.

Lawrence Egbert

If they can establish that Egbert was at the suicide, things could get really interesting, in terms of FEN’s claims of never providing assistance or material. If that’s established, some public comments of Egbert’s in other venues could become relevant. Here’s anexcerpt from a post last May that discusses some of the challenges Egbert could face in the courtroom:

The reporter is pretty careful in most cases in this story to qualify statements about FEN practices with wording such as “the website states.”

That’s important because not all of what the FEN website claims is true. Take this, for example, from the latest article:

A Final Exit Medical Committee reviews information, and if approved, an “Exit Guide” is assigned who provides detailed information how a person may purchase equipment and take steps to end their own life, according to the website.“The Network never supplies equipment,” the website states.That right there – about FEN never supplying equipment. It’s not true. How do we know? The overly-modest and zealous Dr. Larry Egbert told us so, in an interview that appeared in the Washington Post in January:

Egbert tells me that years ago he asked someone who was about to “exit” if he could reuse the hood to save future patients the cost of buying a new one. The patient was delighted with the idea, Egbert says. He started asking everyone.The hood in my bare hands feels slightly slick. So, this one, the one I’m holding, has been used to end someone’s life? I ask. Egbert tells me it has surely been used at least once, and maybe several times, and the same could be said for most of the other 17 hoods in the garbage bag.

So, Egbert, by his own admission, has provided equipment on a regular basis in his work as an ‘exit guide.’ That might seem like a minor point to some in and of itself, but the fact is, there is no way for us – the public – to verify any claim FEN makes. It’s only when someone like Egbert gets to talking and bragging we get to hear some facts that depart from the established script.

Wednesday, March 27, 2013

For the past several years Montana has faced a confusing legal situation with respect to assisted suicide. In 2009, the Baxter court decision declared that Montana citizens had a right to assisted suicide. This decision was appealed to the Supreme Court in Montana that decided that Montana citizens do not have a right to assisted suicide, they did not overturn statute that protected Montana citizens from assisted suicide, but they did grant a tightly worded defense of consent, if a physician was prosecuted for assisted suicide.This mean't that assisted suicide remained illegal in Montana, but if prosecuted, a physician could use the defense of consent. Link: Assisted Suicide is not legal in Montana.During the 2013 Montana legislative session, Compassion & Choices, a lobby group that promotes assisted suicide, supported Bill SB 220, that would have legalized assisted suicide in Montana. Bill SB 220 was defeated in the Senate Judiciary committee in mid-February. Link: Assisted Suicide bill SB 220 defeated in Montana Judiciary Committee.At the same time, the Montanans Against Assisted Suicide were promoting Bill HB 505, a bill that clarified the law and protected Montana citizens from assisted suicide. HB 505 was sponsored by Rep. Krayton Kerns. Link: House Bill 505.In late February HB 505 passed in the Montana House by a vote of 51 to 46 and was sent to the Montana Senate for approval. Link: HB 505 passes.Since that time, a group of 112 physicians has organized to support HB 505 and oppose assisted suicide in Montana. Link: 112 Physicians support HB 505.

Diane Coleman

Diane Coleman, the leader of the disability rights group, Not Dead Yet supports HB 505.On March 26, the Senate Judiciary committee held public hearings on Bill HB 505, listening to interventions from people supporting both sides of the debate. Dr. Eric Kress, a doctor in Missoula Montana, admitted to intentionally prescribing three people a lethal dose, to assist their suicide.We need everyone to contact the members of the Montana Judiciary Committee now and tell them: Vote for HB 505 to protect people from assisted suicide in Montana. The law is currently a mess and it needs clarification.The following article explains:Why Montana needs to pass HB 505 now.

The following letter was written by Philip Lintilac and published in the comment section of the Burlington Free Press on March 25, 2013. The legislature in Vermont has been debating the legalization of assisted suicide nearly every year since 2007. Governor Peter Shumlin is a long-time supporter of assisted suicide and has stated that he will legalize assisted suicide. So far, every year the assisted suicide bill has been defeated and every year it has returned.

I am an 85-year-old Democrat who applauded
your election and has approved of all you have done. However, I must question
your reported support for the bill before the Legislature now on assisted
suicide. This has been touted as solely a matter of individual rights, but it
is a matter of grave concern for the whole community.

Passage of this bill will produce the
occasion for the ultimate abuse of the elderly, targeting the old dependent and
perhaps ailing and depressed who during these hard times can be easily
persuaded that they are a burden on their families and have a duty to release
them. Indeed many elderly already feel like this.

With such wide ignorance of the hospice
programs, which are the real answer to the problem of end-of-life care, and the
number still of doctors untutored in palliative medicine, there can still be
unnecessary suffering of the sick elderly, but the right action is to rectify
these lacks, not to kill off the victims. Some studies have found that
so-called mercy killings happen more to relieve the suffering of onlookers, not
the patients themselves.

Sir, think again -- which is the better
way to serve the community as well as to show compassion?

The medical society has already expressed
its disapproval of this bill, knowing it will seriously affect the public image
of doctors from healers to death-dealers. The young are already too prone to
commit suicide when things get tough -- they do not need the way out modeled
for them by the supposed wiser.

If assisted suicide becomes more common
will society relax its expensive efforts to find cures to deal better with
chronic and end-of-life diseases and the social problems caused by them. Let’s
face it -- the more assisted suicide becomes acceptable to the community, the
more the temptation will be to encourage the practice for social convenience
and economic need as climate changes cause water and food shortages and high
cost medical care continues to take a greater share of the nation’s financial
resources. We could go the path already taken by the Dutch -- not just the
dying elderly with their consent, but the young with chronic diseases and
finally people without their consent are receivers of assisted suicide.

Finally, I believe that no doctor with integrity can say with
certainty that a person has only six months to live -- there have been
remissions and new treatment which have allowed some people to live on for
years and I believe in hope as an ingredient of healing and on erring on the
side of life.

Treating death as sacred

The debate surrounding death with dignity,
or physician-assisted suicide, is understandably polarized; but I think it
misses a very significant point, which is the problem of the sacredness of life
and of death. We hear the issue framed in terms of those who assert that life
is sacred, and that any other position must be profane by definition. But if
life is sacred then isn’t death also sacred? Surely this most profound and
inevitable transition should be sacred too.

Most religions regard death as sacred in
some sense, and provide a means for the dying and the families of the dying to
come to terms with the passing of life in ways that are meaningful to them. How
can we deny individuals and their families the right to respect this final
transition in a way that allows them to control the content and meaning of the
end of life? Where is the humanity in demanding that any conscious effort to
control the circumstances of death is equivalent to suicide or murder? What is
profane about the end of life?

Palliative care services are essential and
if thoughtfully administered can do a lot to relieve suffering, but even the
most well-meaning hospice care has its limits and can reach the point where we
have to face the prospect of being drugged until we can no longer eat and then
dying of starvation. I have seen this and it is not sacred. It is isolating and
it is humiliating. It denies the dying the privilege of spending their last
hours in conscious communion with those who have meant the most to them, and
sharing together the recognition of a life well spent and happily ended.

Death is not profane by definition. It is
a biological inevitability that under the best of circumstances we would all
want to approach without fear. I want to be able to reach out to those I love
when my time comes and die with my boots on. I count that as sacred.

Tuesday, March 26, 2013

There is an ongoing–and potentially lethal–discussion ongoing in bioethics and moral philosophy that would redefine death from the irreversible cessation of cardio/pulmonary function or neurological function, to a diagnosis of permanent unconsciousness. But the unconscious breathe and their bodies function, meaning that they are clearly not biologically dead.

But logic and accuracy are impediments to the agendas being pursued. Indeed, redefining death would break the back of the sanctity/equality of life ethic permitting the fulfillment of several (dire, from my POV) long-time utilitarian societal goals:

Destroy human exceptionalism by denying intrinsic human dignity;

Make the value of human life subjectively depend on quality of neurological function. e.g., “personhood theory;”

Allow the profoundly cognitively disabled to be organ harvested before biological death, in essence killing for organs;

Allow experimentation on living human bodies under the pretext that they are mere cadavers;

Stop all medical care, as now happens with those declared dead, to save resources.

Now, I can add a sixth purpose (or consequence); breaking the general prohibition against active euthanasia.

Heretofore, the redefine death crowd have primarily limited their targets to those with profound and permanent cognitive disabilities caused by injury or disease, such as the late Terri Schaivo. But now, an article published in the Journal of Medicine and Philosophy, (38: 190–204, 2013) by Samuel H Lipuma, argues that permanently sedating a dying patient–a legitimate palliative technique, rarely required–is the same thing as euthanasia. From the article:

The thesis being defended here is not just that there are many similarities between CSD [continuous sedation until death] and PAS/E physician-assisted suicide/euthanasia] but rather that CSD is equivalent to PAS/E. CSD, as it has been defined and clarified here, is the permanent elimination of consciousness from a patient. To have one’s consciousness permanently eliminated is to die. It is a death of higher brain functioning.

Note that it isn’t as if the patient’s consciousness couldn’t be restored. It is that doctors don’t plan to do so because the patient would be in intractable pain. (Also note that most cases–perhaps all, I don’t know–of palliative sedation don’t actually require permanent sedation until death as a matter of medical necessity. That it is sometimes done that way, doesn’t mean it has to be.) Also note that the sedated patient’s body continues to function, often without medical assistance such as a respirator. Thus, by any objective measure, the patient is not dead.

Nor is permanent unconsciousness the same thing as “brain death,” since death by neurological criteria requires that every function of the brain and each of its constituent parts cease functioning as a brain (not that every brain cell be dead). The brain of a sedated patient has not ceased functioning as a brain. The drugs have merely rendered the patient unconscious.

Not only that, but supposed permanent unconsciousness isn’t necessarily unaware. There have been many recorded instances of unconscious patients, with no seeming higher brain function, recalling precisely what happened during that time. And recent neurological screening breakthroughs have shown that some supposedly permanently unaware patients are able to interact. Heck, we don’t actually know what consciousness is!

Back to Lipuma. He, and his ilk, seek to redefine death from a biological into a sociological meaning, from a condition that can be determined (at least theoretically) objectively through medical means, to a subjective approach in which death to one person is not death in another. From his conclusion:

The thesis being defended here does not involve moral evaluation. It claims that CSD is indistinguishable from PAS/E. To say that CSD occurred would be to say that killing occurred. That does not make it immoral because context determines when killing is or is not justifiable. Self-defense involves killing but is morally justifiable. CSD is also morally justifiable because it rests on the principles of respect for patient autonomy, mercy, compassion, and physician nonabandonment…

The present concern is to demonstrate the claim that no significant differences can be made between acts of CSD and those of PAS/E. For those insisting that life and death should be understood biologically,the case could be made that CSD is not death. This can only be done at the expense of a definition of death based on consciousness and all other human awareness and instead forces us into a much less desirable “one size fits all” notion of death. This does not do justice to being human and the significance that consciousness and all other human awareness abilities have to human life.

Identifying CSD with higher brain death is a more precise and accurate characterization of what occurs. Clarifying our actions to the greatest possible extent should help us improve the care of the immanently dying. That is the fundamental inspiration behind this analysis.

Like I always say: If you want to see where the culture is going wrong, just read the professional journals.

The following is a speech by Chief Justice Sundaresh Menon at the Singapore Medical Association Annual lecture on March 9, 2013. Link to the original article.

(Alex Schadenberg found this article to be very interesting and worth reading. He does not agree with every point in the article.)

Chief Justice Sundaresh Menon

Introduction

In a sense it all began here, in a bar in Singapore in 1995, when a young Englishwoman met a Cuban jazz musician and, despite her not being able to speak a word of Spanish and him not being able to utter a word of English, they fell in love.

Debbie Purdy had already begun to experience early symptoms of Multiple Sclerosis when she met Omar Puente, but in the first flush of their relationship, any thought of death and disease must have been the furthest thing from their minds. One would hope that they look back on their time in Singapore as a brief stop in paradise, given how much they have endured together since. They travelled through Asia for the next three years as Ms Purdy's health steadily deteriorated, gradually leaving her more dependent on her companion. When it was time for her to return to England, he followed. In the teeth of the odds, they have been together for the past 18 years, during which time she has become the most prominent face of the assisted dying debate in the UK, and the subject of what is perhaps the most important decision of the House of Lords bearing on the extent of the individual's right to control the circumstances of her death. Theirs is both a legal saga and a love story, and it serves to remind us that - whatever our political, religious or moral leanings - the assisted dying debate remains an irreducibly human issue. It follows that we must summon all the compassion and kindness in our hearts when broaching this matter.

I would like to acknowledge the assistance of my law clerk, Jonathan Yap, who assisted me in researching and preparing this paper and who discussed these ideas with me.

Monday, March 25, 2013

Montanans have a libertarian leaning towards a live-and-let-live philosophy, but what about live-and-let-die?

Physician-assisted suicide continues to be the subject of legislation in Helena, and so far lawmakers have justifiably advanced legislation that would ban the practice and make it clear that “consent of the victim” is not a valid defense for a physician who assists a person with suicide.

One’s initial reaction might be to wonder why the Legislature is putting itself in a position of interfering with the autonomy of a person to choose their own demise with medical assistance. Advocates of physician-assisted suicide, after all, can and do bring heart-wrenching testimonials about people with horrible diseases simply wanting help in ending their lives.

But there are also plenty of reasons why more than 100 legislative proposals nationwide to allow physician-assisted suicide have been rejected, and why 112 Montana doctors support the bill that would ban it. Many of those reasons come from the experience of Oregon and Washington, states that passed ballot initiatives to allow physician-assisted suicide.

In those states, suicides usually aren’t actually “assisted” by physicians; doctors instead provide lethal prescriptions at the request of individuals who are mostly left on their own.

There is the story of an Oregon woman who had cancer and chose suicide 12 years ago, only to be talked out of it by her doctor. Now she is alive and well because she pursued treatment instead, and thankful that she did.

Let’s face it — serious illness is also often accompanied by depression. That means people may not be “in their right mind” when they choose suicide. The pain of chemotherapy or other treatments may make death seem like the preferred alternative, but would those people really give up years of quality life experience with children and grandchildren if they were given hope instead of a deadly drug cocktail?

There is also an abundance of stories about the dangerous influence of money when assisted suicide is an option. The “right to die” can become a “duty to die” when the cost of care comes into play, particularly at a time when health-care costs are soaring. And believe it or not, there have been cases of relatives advising suicide when there are inheritances or life insurance involved. Two words sum it up: “elder abuse.”

In the age of Obamacare, we have to wonder what route government health-care commissars would prefer to see chosen: a few pills or expensive end-of-life care?

Essentially, assisted-suicide laws have the effect of incentivizing suicide. In Oregon, the overall suicide rate has increased 35 percent since assisted suicide was legalized. Another fundamental effect is that the law turns the relationship between doctors and patients upside down. Doctors are trained to heal, not how to help someone die, and that’s why House Bill 505 has the support of so many doctors.

The bill, which passed the House on a 54-45 vote and is now awaiting action in the Senate, would not prevent doctors from providing a full range of end-of-life care, including palliative care, or providing pain medication, that can eventually lead to death.

Montana has been in limbo in regards to physician-assisted suicide ever since the state Supreme Court came out with a ruling in 2009 that muddied the matter, making consent of the victim a possible defense for doctors while not addressing whether others, such as family members, could be held criminally liable in a suicide case.

There is a need for clarity. Yes, it is a complicated issue, but it seems to us that the state should never condone the taking of innocent life. Therefore, even though we sympathize with the intentions of those who support physician-assisted suicide, we urge the Legislature to err on the side of life, not on the side of death.

Saturday, March 23, 2013

"I’m
Jeanette Hall. If my doctor had believed in assisted suicide, I would be dead. Don’t let assisted suicide come to Montana. Tell your legislators to vote “Yes”
on House Bill 505!"

Paul Gorsuch, MD:

"I’m Dr. Paul Gorsuch. On
behalf of myself and a hundred other doctors, I urge you to support House Bill
505. House Bill 505 will protect the 'Jeanette Halls' of the world. Twelve
years ago, she had cancer and decided to 'do' Oregon's assisted suicide law.
Her doctor convinced her to be treated instead."

Friday, March 22, 2013

PRESS RELEASEFOR : IMMEDIATE RELEASE, March 22 2013FROM: 112 Physicians Who Support HB 505CONTACT: Paul Gorsuch, 406 788 8261, Paul Gorsuch SUBJECT: Bill Will End the Confusion on Physician-Assisted Suicide; Will Protect Patients and DoctorsGREAT FALLS - We are 112 Montana physicians who have joined together to support HB 505.House Bill 505 is a short and simple bill that will clarify the law of physician-assisted suicide by clearly providing that physician-assisted suicide is not legal in Montana. We support HB 505 because it will protect patients and our profession. See our ad with all of our names, cities and towns now running in many Montana papers.*HB 505 will be heard in the Senate Judiciary Committee on Tuesday, March 26, 2013 at 9 am. Call 406 444 4800 and tell the Committee to vote “Yes” on HB 505.Physician assisted suicide means a physician prescribes a lethal medication to another person to commit suicide. This practice is open to abuse and error.“Physician-assisted suicide is fundamentally incompatible with the physicians’ role as healer, would be difficult or impossible to control, and would pose serious societal risks.” (AMA ethics opinion 2.211).We Support HB 505:

- We Support HB 505 because it will protect the “Jeanette Halls” of the world. Twelve years ago, she had cancer and decided to “do” Oregon’s assisted suicide law. Her doctor talked her out of it and convinced her to be treated instead. Today, she is “thrilled to be alive.” Her photo is in our ad. She states: “If my doctor had believed in assisted suicide, I would be dead.”

- We Support HB 505 because it will protect our patients.

- We Support HB 505 because it is a NORMAL LAW (only two states allow doctors to assist suicides). HB 505 does NOT “send doctors to prison” or prevent doctors from providing the full range of end of life care including palliative care and treatment withdrawal. If you READ THE BILL, this is clear.

The following is an excerpt from the recent blog article by Wesley Smith concerning his testimony in Texas opposing Senate Bill SB 303 that would make DNR decisions the sole right of doctors, without needing to consult. Texas doctors are moving the same direction as the "doctors" in the Rasouli case in Canada who are demanding the unilateral right to decide to withdraw life-sustaining treatment or care.

What has not been clear is what happened to older hospital patients who left the hospital after a cardiac arrest. Now a new study in The New England Journal of Medicine of 6,972 elderly people who survived in-hospital cardiac arrests between 2000 and 2008 gives some answers. A year after exiting the hospital, 58.5 percent of these older patients were still alive. Of this group, 48 percent had little or no neurological impairment, while 52 percent had moderate or severe neurological damage. Forty percent of older patients who survived CPR returned to life at home; the remaining 60 percent went to nursing homes, rehabilitation facilities or hospices.

And some of that data is more than ten years old, a long time in the medical field in which advancements come exponentially. Indeed, I am reading a fascinating book entitled Erasing Death, which is, among other issues, about the vast improvements in rehabilitation science and how innovative approaches are leading to amazing recoveries with restored function in people who would once have been “not only merely dead, but really most sincerely dead,” as the Wizard of Oz song lyric had it.

Judith Graham

Graham quotes a physician who properly notes that the issues of CPR and DNR are for patients to decide:

Older people and their families may want to use findings from this report in discussions about end-of-life care and preparing advance directives, which can include “do not resuscitate” orders.“I think physicians should discuss these results with patients and ask what their wishes are should their hearts stop,” Dr. Chan said. Unfortunately, there is no research on how elderly survivors of cardiac arrest rate their quality of life and whether they would choose resuscitation again if they had the opportunity, he noted.

“One of the most important questions to ask is, what is the older person’s current level of functional ability and cognitive status,” Dr. Abella said, observing that “elderly patients with good pre-cardiac arrest function tend to do much better. If an older patient is cognitively intact and in reasonably good health, he or she might want to consider allowing resuscitative care,” Dr. Abella said. “But ultimately, this is a very personal, individualized decision.”

The DNR decision should be the patient’s, not the doctor’s or that of strangers meeting in a secret ethics committee deliberation!

Texas supporters of SB 303 claim they only want to prevent patient suffering. Fine. But I also think this has a lot to do with money. ... I am not so sure that improved resuscitation results for elderly and other expensive patients will be a welcomed development among our Health Care Technocratic would-be overlords.

Thursday, March 21, 2013

I recently saw an ad by "Compassion and Choices" which contained an over-the-top depiction of a doctor in handcuffs. This ad is appalling, even by the low standards of Compassion in Choices. (Compassion and Choices is a successor organization of the Hemlock Society, originally founded by Derek Humphry. In 2011, Humphry was keynote speaker and Compassion and Choices annual meeting here in Washington. He was also in the news as a promoter of mail-order suicide kits after a 29 year old man used one of the kits to commit suicide).*HB 505 is needed to protect seniors and others from the ultimate in financial and physical abuse. I urge you to vote YES. Thank you.For supporting authority and more information, go here: link.

Palo Alto, CA (Law Firm Newswire) March 21, 2013 – In Sacramento, the operator of an elder-care facility is currently facing felony charges after the death of a resident.The owner of Super Home Care, Silvia Cata, was arrested and charged with felony charges of elder abuse and involuntary manslaughter regarding the death of a woman in her care.The resident, Georgia Holzmeister, was 88. She had dementia and received care at Super Home Care since 2007. She died from severe bedsores which resulted in sepsis, a toxic response to bacteria or germs. While bedsores can be difficult to avoid entirely, the emergency room doctor who treated her later told investigators that Holzmeister’s bedsores were typed Stage 4, among the worst he had ever witnessed.“This is believed to be the first time California’s Department of Justice has filed manslaughter charges against an elder-care caregiver regarding resident care,” stated Palo Alto elder law attorney Michael Gilfix.California has rarely pursued criminal prosecution of elder care workers. Allegations of elder abuse and neglect are typically handled in civil court. Cata faces get as much as 12 years in prison if convicted. Two additional allegations are that the victim suffered “great bodily injury” and the abuse she suffered caused her death. An involuntary manslaughter conviction carries a maximum of four years. Cata is currently in the Sacramento County Jail, in lieu of $300,000 bail.Cata, her spouse and her adult daughter were listed as Holzmeister’s caregivers. Cata has been licensed in California to operate a residential elder care facility since 1996. Though she is licensed to care for as many as six individuals, she stated that she usually cares for two or three residents. Previously, Cata was cited by state licensing officials for dispensing over-the-counter medication without medical orders, poor record keeping, and caring for a resident who was found to need a higher level of skilled nursing care. Holzmeister’s family paid between $2,000 and $2,800 monthly for her care.Individuals who suspect elder abuse or neglect can speak with an elder law attorney to pursue any concerns. It is not necessary to have proof of neglect or abuse; anyone with any concern that there may be abuse is encouraged to file a complaint so that an investigation can begin.To learn more, visit Gilfix & La Poll Associates LLP at http://www.gilfix.com/.Gilfix & La Poll Associates LLP2300 Geng Rd., Suite 200Palo Alto, CA 94303Telephone: (650) 493-8070http://www.gilfix.com/

The following letter was sent by Diane Coleman, the founder and President of the disability rights group, Not Dead Yet to the members of the Montana Senate Judiciary Committee who will be considering a bill to clarify and protect Montana citizens from assisted suicide.

Diane Coleman

Dear Senate Judiciary Committee Member:Not Dead Yet is a national disability rights group with members in Montana. On behalf of our members, I write to say that we urge you to pass HB 505, which is a short and simple bill to prevent legalization of assisted suicide and end the dispute over whether it is legal in Montana.In the last two years, three other states have strengthened their laws against assisted suicide (Idaho, Georgia and Louisiana). Not Dead Yet of Georgia was involved in the Georgia efforts. We met with a woman, Sue Celmer, whose ex-husband had been assisted to commit suicide by the Final Exit Network. He had previously battled cancer, but was cancer free when these suicide predators assisted him. Her story helped convey the urgency of legislation banning assisted suicide. We hope that Montana will join Georgia and the other two states to protect older people, our families and ourselves. Leading proponents of bills to legalize assisted suicide for the terminally ill often claim that the views of disability organizations aren’t relevant. While it’s true that people with disabilities aren’t usually terminally ill, the terminally ill are almost always disabled. This is one of many reasons that our perspective may shed some light on this complex issue.People with disabilities and chronic conditions live on the front lines of the health care system that serves (and too often under serves) dying people. One might view us as the proverbial “canaries in the coal mine” who are alerting others to dangers we see first.Assisted suicide supporters paint themselves as “compassionate progressives” fighting for freedom against the “religious right.” It’s a simple message, and it goes down well, if you ignore inconvenient truths, such as:

• Predictions that someone will die in six months are often wrong;• People who want to die usually have treatable depression and/or need better palliative care;• Pressures to cut health care costs in the current fiscal climate make this the wrong time to add doctor prescribed suicide to the options;• Abuse of elders and people with disabilities is a growing but often undetected problem, making coercion virtually impossible to identify or prevent. It’s not the proponents’ good intentions but the language and implementation of assisted suicide laws that legislators need to consider.

As one of countless disabled people who’s survived a terminal prediction, I can’t help but become concerned when the accuracy of a terminal prognosis determines whether someone gets suicide assistance rather than suicide prevention.The Oregon Reports themselves show that non terminal people are getting lethal prescriptions – up to 1009 days have passed between the request for a lethal prescription and death. One of the many things the Reports hide is specifically how many lived longer than six months, but we do know that there’s no consequence to the assisting doctors for this or any other mistake in the assisted suicide process.Proponents also claim that 15 years of data from Oregon show that safeguards to ensure that it's voluntary are working. How would they know? The Oregon Reports only tell us what the prescribing doctors indicated were the patients’ reasons for wanting assisted suicide by checking off one or more of seven reasons on a multiple choice state government form.One of the reasons is feelings of being a burden on others, checked in 39% of the cases. But there’s no corresponding requirement that home care options be disclosed as part of informed consent under the law, much less that they be offered or funded.Although the Oregon Reports admit that the state can’t assess compliance with the safeguards, some independent articles find that safeguards failed in individual cases (see, e.g., Hendin & Foley, MDs, “Physician-Assisted Suicide in Oregon: A Medical Perspective”, Michigan Law Review, June 2008, http://www.michiganlawreview.org/assets/pdfs/106/8/hendinfoley.pdf). But the law includes no authority for investigation or enforcement, so nothing happens as a result.It has been estimated that there are 21,265 reported and unreported cases of elder abuse annually in Montana (Elder Abuse Data and Statistics, Elder Abuse Daily, February 15, 2010 http://web.archive.org/web/20101021101332/http://www.eadaily.com/15/elder-abuse-statistics/). Statistically, 90% of elder abusers are a family member or trusted other. Similarly, people with disabilities are up to four times more likely to be abused than their same-age nondisabled peers. In Oregon and Washington, legal assisted suicide has opened new paths of abuse against persons who may qualify to use these laws. One of the most obvious problems is a complete lack of oversight when the lethal drug is administered. If an abuser were to administer the drug without the person’s consent, who would know?It is simply naive to suggest that assisted suicide can be added to the array of medical treatment options, without taking into account the harsh realities of elder abuse and the related potential for coercion.We urge you to vote in favor of HB 505.Sincerely,Diane Coleman, JD, MBAPresident/CEO Not Dead Yet497 State Street Rochester, NY 14608www.notdeadyet.org